Add-on multidrug treatment based on quadruple therapy successfully treated worsening heart failure caused by anthracycline-induced cardiomyopathy in a survivor of cancer as a young adult: a case report

• Published in: BMC cardiovascular disorders Vol. 24; no. 1; pp. 505 - 8
• Main Authors: Oda, Hirotaka, Hayashi, Yuka, Oyanagi, Norihito, Tanaka, Komei, Ozaki, Kazuyuki, Kashiwa, Asami, Hosaka, Yukio, Tsuchida, Keiichi, Takahashi, Kazuyoshi
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 20.09.2024; BioMed Central; BMC
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Aminobutyrates - adverse effects; Aminobutyrates - therapeutic use; Anthracycline; Anthracycline-induced cardiomyopathy; Anthracyclines; Anthracyclines - adverse effects; Antihypertensives; Aortic stenosis; Aortic valve; Aortic valve stenosis; Biphenyl Compounds; Calcification; Cancer; Cancer survivor; Cancer Survivors; Cancer therapies; Cardiac arrhythmia; Cardiac patients; Cardiac reverse remodeling; Cardiomyocytes; Cardiomyopathies - chemically induced; Cardiomyopathies - diagnosis; Cardiomyopathies - physiopathology; Cardiomyopathy; Cardiotoxicity; Cardiovascular Agents - administration & dosage; Cardiovascular Agents - adverse effects; Cardiovascular Agents - therapeutic use; Cardiovascular diseases; Care and treatment; Case reports; Case studies; Chemotherapy; Children; Colorectal cancer; Complications and side effects; Congestive heart failure; Disease Progression; Diuretics; Drug Combinations; Drug dosages; Drug therapy; Drug Therapy, Combination; Dyspnea; Ejection fraction; Electrocardiography; Exercise; Glucose transporter; Guanylate cyclase; Heart diseases; Heart failure; Heart Failure - chemically induced; Heart Failure - diagnosis; Heart Failure - drug therapy; Heart Failure - physiopathology; Humans; Hypertension; Intubation; Ivabradine; Male; Medical prognosis; Mineralocorticoid Receptor Antagonists - therapeutic use; Morbidity; Mortality; Prognosis; Pulmonary arteries; Senescence; Sodium-Glucose Transporter 2 Inhibitors - adverse effects; Sodium-Glucose Transporter 2 Inhibitors - therapeutic use; Spironolactone; Teenagers; Treatment Outcome; Valsartan; Ventricular Function, Left - drug effects; Vericiguat; Worsening heart failure; Young Adult; Young adults; Youth; Japan; Aortic stenosis; Case report; Vericiguat; Anthracycline-induced cardiomyopathy; Worsening heart failure; Cardiac reverse remodeling; Cancer survivor; Quadruple therapy
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-024-04189-z

The overall mortality and morbidity benefit in patients with heart failure with a reduced ejection fraction is greatest with a treatment combination of sacubitril/valsartan, beta-blockers, mineralocorticoid-receptor antagonists, and sodium-glucose transporter-2 inhibitors, termed the "fantastic four" or "quadruple therapy." The addition of vericiguat (an oral soluble guanylate cyclase stimulator) is believed to aid in managing worsening heart failure after quadruple therapy. Among childhood and young adult cancer survivors, cardiovascular complications that develop more than 10 years after anthracycline-based chemotherapy have a poor prognosis. Therefore, this study reports the efficacy of multidrug regimen based on quadruple therapy for worsening heart failure in cancer survivors with anthracycline-induced cardiomyopathy. A survivor of cancer as a young adult who received high-dose anthracycline chemotherapy presented with acute decompensated heart failure 20 years post-chemotherapy and worsening heart failure 1.5 years after discharge. The patient showed signs of improvement after a step-wise introduction of carvedilol, empagliflozin, sacubitril/valsartan, ivabradine, and spironolactone for worsening heart failure. Vericiguat was accelerated owing to the risk of more severe cardiovascular events associated with ongoing aortic stenosis and the poor prognosis of anthracycline-induced cardiomyopathy. Heart failure symptoms continued to improve, with significant cardiac reverse remodeling, and the patient successfully underwent aortic valve replacement for severe aortic stenosis. Our case highlighted that multidrug treatment with add-on vericiguat and ivabradine based on quadruple therapy can potentially treat worsening heart failure in young adult cancer survivors with severe anthracycline-induced cardiomyopathy.